DMPA contraceptives linked to increased HIV risk

Evidence observed in an updated systematic review published in AIDS suggests that use of depot medroxyprogesterone acetate (DMPA) contraception may be associated with an increased risk of HIV acquisition in women.

Chelsea B. Polis, PhD, from the Guttmacher Institute in New York and the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, and colleagues identified studies published between January 15, 2014, and January 15, 2016, that compared users of a specific hormonal contraception with either nonusers of hormonal contraception or with users a different type of contraception.

The authors note that the possible association “is critically important for women's health, particularly in sub-Saharan Africa, where high rates of HIV coincide with high use of injectable contraception. Many regions with high HIV prevalence also have high rates of unmet need for contraception, unintended pregnancy, and maternal mortality and morbidity, underlying the imperative for access to effective contraception.”

The researchers added newly identified studies to those used in a previous review that included evidence prior to January 2014. They assessed study quality and conducted a meta-analysis to compare use of DMPA with non-use of hormonal contraception. The investigators identified 5 new reports and focused on 9 additional reports from the previous review that were considered “informative but with important limitations.”

The data did not suggest that there is an association between HIV acquisition and the use of oral contraceptive pills, injectable norethisterone enanthate, or levonorgestrel implants.

The researchers concluded that if the association between DMPA and HIV risk is causal, the data suggest an increase in risk of hazard ratios 1.5 or less. They note that more discussion is needed to evaluate study quality with the current evidence.

“An important next step is for WHO [World Health Organization] to determine whether these concerns warrant a reconsideration of global guidance for DMPA,” they wrote. “Modeling studies can be useful in understanding net health impacts of various policy responses in different epidemiological contexts, including the risk of HIV, maternal mortality and morbidity, and access to alternative contraception and HIV prevention methods.”

ClinicalAdvisor.com is for nurse practitioners and physician assistants, offering the latest information on diagnosing, treating, managing, and preventing medical conditions typically seen in the office-based primary-care setting.

Find all of the news and departments you love from the print issue archived for easy online access, along with special Web-only content.